选择性半肝血流阻断下腹腔镜右半肝切除术七例  

Laparoscopic right hemihepatectomy under selective hemihepatic inflow occlusion

作　　者：蔡柳颓[1] 程敏玲[1] 杜学峰[1] 李振宇[1] 

机构地区：[1]温州医学院附属台州医院肝胆外科,317000

出　　处：《中华普通外科杂志》2012年第6期459-462,共4页Chinese Journal of General Surgery

摘　　要：目的探讨选择性半肝血流阻断下腹腔镜右半肝切除术的可行性与安全性。方法解剖右侧肝门，在选择性半肝血流阻断下，采用腹腔镜多功能手术解剖器（ laparoscopic Peng＇ s muhifunetional operative dissector, LPMOD ）刮吸断肝技术行肝脏良性疾病腹腔镜右半肝切除术7例。结果除1例右肝血管瘤患者因中肝静脉属支出血难以控制，做小切口辅助止血而完成手术外，其余6例均完成选择性半肝血流阻断下腹腔镜右半肝切除术。手术时间300～540min，平均（399±75）min，其中解剖肝门时间30—75min，平均（51±16）min，切肝时间60—160min，平均（116±32）min，术中出血600～3000ml，平均（1486±809）rnl，术后丙氨酸转氨酶（ALT）升高至（302～557）U／L，平均（386±85）U／L，恢复正常水平5～11d，平均（7．1±2．0）d。术后住院时间10～18d，平均（12．4±2．6）d。术后2～4d下床，术后1～4d进食，术后2—4d肛门排气，无严重并发症发生。结论选择性半肝血流阻断下行腹腔镜右半肝切除术是安全可行的。Objective To evaluate the feasibility and safety of laparoscopic right hemihepatectomy under selective hemihepatic inflow occlusion. Methods In performing this procedure, first dissect the right hepatic portal, and under selective hemihepatic inflow occlusion, laparoscopic Peng＇s multifunctional operative dissector （LPMOD） was used to transect the hepatic parenchyma by stepwise curettage and aspiration. Results Procedures were successful in all six patients of benign liver diseases, though a small subcostal auxiliary incision was needed in one case to control the middle hepatic vein branch hemorrhage. Operation time was 300 - 540 min [ mean, （ 399 ± 75 ） min ]. The time of hepatic portal dissect was 30 -75 min[ mean, （51 ± 16） mini. The time of liver parenchyma transection was 60 - 160 min [ mean, （116 ±32） mini. Intraoperative blood loss was 600 -3000 ml [ mean, （1486 ±809） ml]. The level of ALT increased to （302 -557） U/L[ mean, （386 ± 85） U/L] after the operation, and back to normal level in 5 - 11 d [ mean, （7. 1 ± 2. 0） d ]. The postoperative hospital stay was 10 - 18 d [ mean, （ 12.4 ± 2. 6） d ]. No severe complication occurred after the operation. Conclusions Laparoseopic right hemihepateetomy under selective hemihepatic inflow occlusion is safe and feasible.

关 键 词：肝切除术 腹腔镜检查 选择性半肝血流阻断 

分 类 号：R657.3[医药卫生—外科学]